The On-X prosthesis is the only mechanical aortic valve available in the market to have a proved safety and feasibility at lower INR regimen. The aims of this retrospective study were to evaluate the early and mid-term outcomes of the modified Bentall procedure with the O4n-X mechanical conduit.
From January 2012 to December 2016, 108 consecutive patients (mean age 51.9 ± 12.5 years) underwent Bentall operation with On-X in our institution. Main indications were degenerative ascending aorta aneurysms (55.6%) and aortic dissections (20.4%). Seventeen (15.7%) were redo operations. Associated procedures were performed in 40 cases (37.0%); of them, 27 (25.0%) were complete or partial arch replacements. Mean follow-up time was 35.1 ± 16.1 months (97.1% complete). After 2015, a lower INR regimen of 1.5 to 2 was applied in association with aspirin.
Overall In-hospital mortality was 2.8%. Morbidity included: 1 stroke (0.9%), 2 acute kidney injuries (2.9%) and 5 re-thoracotomies for bleeding (4.6%). Actuarial survival at 5 years was 95.2 %. Freedom from aortic re-operation was 100%. At 5 years no thromboembolic or haemorrhagic events were observed and only 1 patient had an infective endocarditis (figure 1).
The modified Bentall operation confirmed to be a safe and durable operation for the treatment of ascending aorta pathologies. The On-X conduit showed very satisfactory early results even in cases with unfavourable anatomy. This prosthesis also guarantees safe mid-term durability associated with a very low incidence of thromboembolism regardless of the lower INR regimen.
Cardio-toraco-vascolare, Policlinico di S. Orsola, Università di Bologna Bologna